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2.
A A Pract ; 15(3): e01392, 2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1151699

RESUMEN

Ventilator shortages occurred due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This in vitro study evaluated the effectiveness of 3-dimensional (3D)-printed splitters and 3D-printed air flow limiters (AFL) in delivering appropriate tidal volumes (TV) to lungs with different compliances. Groups were divided according to the size of the AFL: AFL-4 was a 4-mm device, AFL-5 a 5-mm device, AFL-6 a 6-mm device, and no limiter (control). A ventilator was split to supply TV to 2 artificial lungs with different compliances. The AFL improved TV distribution.


Asunto(s)
/epidemiología , Servicios Médicos de Urgencia/métodos , Rendimiento Pulmonar/fisiología , Impresión Tridimensional , Ventiladores Mecánicos/provisión & distribución , Humanos , Pulmón/fisiología , Masculino , Volumen de Ventilación Pulmonar/fisiología
4.
World Neurosurg ; 148: e172-e181, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1078227

RESUMEN

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Asunto(s)
/epidemiología , Hospitales Universitarios/organización & administración , Neurocirugia/organización & administración , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Centros Médicos Académicos/organización & administración , Neoplasias Encefálicas/cirugía , California/epidemiología , Derivaciones del Líquido Cefalorraquídeo/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos , Procedimientos Endovasculares/estadística & datos numéricos , Capacidad de Camas en Hospitales , Departamentos de Hospitales/organización & administración , Humanos , Control de Infecciones , Difusión de la Información/métodos , Unidades de Cuidados Intensivos , Laboratorios de Hospital , Sistemas Multiinstitucionales , Quirófanos , Política Organizacional , Equipo de Protección Personal/provisión & distribución , Estudios Retrospectivos , Medición de Riesgo , Capacidad de Reacción , Triaje , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos , Ventiladores Mecánicos/provisión & distribución , Heridas y Traumatismos/cirugía
5.
Bioethics ; 35(2): 125-134, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1066621

RESUMEN

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Asunto(s)
/terapia , Asignación de Recursos para la Atención de Salud , Nivel de Atención/ética , Triaje/ética , Factores de Edad , Europa (Continente)/epidemiología , Personal de Salud/ética , Personal de Salud/psicología , Prioridades en Salud , Hospitalización , Derechos Humanos , Humanos , Unidades de Cuidados Intensivos/ética , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento , Ventiladores Mecánicos/provisión & distribución , Privación de Tratamiento/ética
6.
BMJ Open ; 11(1): e042945, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1050402

RESUMEN

OBJECTIVE: In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. DESIGN: Descriptive survey. SETTING: All non-specialist secondary care providers in England from 27 March27to 5 June 2020. PARTICIPANTS: Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). MAIN OUTCOME MEASURES: Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. RESULTS: At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. CONCLUSIONS: Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.


Asunto(s)
/epidemiología , Capacidad de Camas en Hospitales , Hospitales/provisión & distribución , Capacidad de Reacción , Ventiladores Mecánicos/provisión & distribución , Ocupación de Camas/estadística & datos numéricos , Inglaterra/epidemiología , Personal de Salud , Humanos , Unidades de Cuidados Intensivos/provisión & distribución , Medicina Estatal
7.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 106-111, 2020.
Artículo en Inglés | LILACS (Américas) | ID: covidwho-1043418

RESUMEN

SUMMARY The respiratory disease caused by the coronavirus SARS-CoV-2 (COVID-19) is a pandemic that produces a large number of simultaneous patients with severe symptoms and in need of special hospital care, overloading the infrastructure of health services. All of these demands generate the need to ration equipment and interventions. Faced with this imbalance, how, when, and who decides, there is the impact of the stressful systems of professionals who are at the front line of care and, in the background, issues inherent to human subjectivity. Along this path, the idea of using artificial intelligence algorithms to replace health professionals in the decision-making process also arises. In this context, there is the ethical question of how to manage the demands produced by the pandemic. The objective of this work is to reflect, from the point of view of medical ethics, on the basic principles of the choices made by the health teams, during the COVID-19 pandemic, whose resources are scarce and decisions cause anguish and restlessness. The ethical values for the rationing of health resources in an epidemic must converge to some proposals based on fundamental values such as maximizing the benefits produced by scarce resources, treating people equally, promoting and recommending instrumental values, giving priority to critical situations. Naturally, different judgments will occur in different circumstances, but transparency is essential to ensure public trust. In this way, it is possible to develop prioritization guidelines using well-defined values and ethical recommendations to achieve fair resource allocation.


RESUMO A doença respiratória provocada pelo coronavírus 2019 (COVID-19) é uma pandemia que produz uma grande quantidade simultânea de doentes com sintomas graves que necessitam de cuidados hospitalares especiais, sobrecarregando a infraestrutura dos serviços de saúde. Todas essas demandas geram a necessidade de racionar equipamentos e intervenções. Diante desse desequilíbrio, como, quando e quem decide, há o impacto dos sistemas estressores dos profissionais que se encontram na linha de frente do atendimento e, em segundo plano, questões inerentes à subjetividade humana. Nesse percurso, surge ainda a ideia do uso de algoritmos da inteligência artificial para substituir o profissional de saúde nessa tomada de decisão. Nesse contexto, fica o questionamento ético de como gerenciar as demandas produzidas pela pandemia. O objetivo deste trabalho é refletir, do ponto de vista da ética médica, sobre princípios basilares das escolhas executadas pelas equipes de saúde, no enfrentamento da pandemia da COVID-19, cujos recursos são escassos e as decisões ocasionam angústia e inquietação. Os valores éticos para o racionamento de recursos de saúde em uma epidemia devem convergir para algumas propostas embasadas em valores fundamentais, como maximizar os benefícios produzidos por recursos escassos, tratar as pessoas de forma igualitária, promover e recomendar os valores instrumentais, dar prioridade para situações críticas. Naturalmente ocorrerão julgamentos diferentes em circunstâncias distintas, mas é fundamental que haja transparência para garantir a confiança pública. Desse modo, é possível elaborar diretrizes de priorização utilizando valores e recomendações éticas bem delineados para atingir procedimentos justos de alocação de recursos.


Asunto(s)
Humanos , Neumonía Viral/epidemiología , Asignación de Recursos para la Atención de Salud/ética , Triaje/ética , Infecciones por Coronavirus/epidemiología , Pandemias , Toma de Decisiones Clínicas/ética , Neumonía Viral/terapia , Inteligencia Artificial , Ventiladores Mecánicos/provisión & distribución , Infecciones por Coronavirus , Infecciones por Coronavirus/terapia , Betacoronavirus
9.
Front Public Health ; 8: 587423, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1000209

RESUMEN

COVID-19 has overwhelmed healthcare systems across the globe with an unprecedented surge in the demand for hospitalizations. Consequently, many hospitals are facing precarious conditions due to limited capacity, especially in the provision of ventilators. The governing ethical principles of medical practice delineated in (1) favor prioritizing younger patients, largely because of their relatively higher expected life years. We conduct a survey of the general public in the United States to elicit their preferences for the allocation of a limited number of ventilators. The results show that the general public views align with the established ethical principles, which favor younger patients. JEL Classification: C91.


Asunto(s)
Asignación de Recursos para la Atención de Salud/ética , Hospitalización , Pronóstico , Asignación de Recursos , Triaje/ética , Adulto , Femenino , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida , Estados Unidos , Ventiladores Mecánicos/provisión & distribución
11.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-983117

RESUMEN

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Asunto(s)
Citas y Horarios , Infecciones por Coronavirus/terapia , Cuidados Críticos , Prestación Integrada de Atención de Salud , Procedimientos Quirúrgicos Electivos , Unidades de Cuidados Intensivos/provisión & distribución , Admisión del Paciente , Neumonía Viral/terapia , Capacidad de Reacción , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Necesidades y Demandas de Servicios de Salud , Humanos , Evaluación de Necesidades , New York/epidemiología , Sistemas de Información en Quirófanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Respiración Artificial , Factores de Tiempo , Ventiladores Mecánicos/provisión & distribución
12.
PLoS One ; 15(10): e0241027, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-883688

RESUMEN

As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Recursos en Salud/provisión & distribución , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Algoritmos , Infecciones por Coronavirus/virología , Cuidados Críticos , Capacidad de Camas en Hospitales , Humanos , Unidades de Cuidados Intensivos/provisión & distribución , Pandemias , Transferencia de Pacientes , Neumonía Viral/virología , España/epidemiología , Reino Unido/epidemiología , Ventiladores Mecánicos/provisión & distribución
13.
Elife ; 92020 10 12.
Artículo en Inglés | MEDLINE | ID: covidwho-844205

RESUMEN

This study examined records of 2566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively. Pneumonia severity scores achieve respective accuracies of 73% and 74% for ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Necesidades y Demandas de Servicios de Salud , Pandemias , Neumonía Viral/terapia , Adulto , Anciano , Área Bajo la Curva , Índice de Masa Corporal , Comorbilidad , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Unidades de Cuidados Intensivos/provisión & distribución , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Dinámicas no Lineales , Neumonía Viral/epidemiología , Utilización de Procedimientos y Técnicas , Curva ROC , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , Ventiladores Mecánicos/provisión & distribución
14.
Respir Care ; 65(7): 920-931, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-840991

RESUMEN

BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded. RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes. CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.


Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Infecciones por Coronavirus , Rendimiento Pulmonar/fisiología , Ensayo de Materiales/métodos , Pandemias , Neumonía Viral , Respiración Artificial , Betacoronavirus , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diseño de Equipo , Humanos , Modelos Biológicos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Ventiladores Mecánicos/normas , Ventiladores Mecánicos/provisión & distribución
17.
Anesthesiology ; 133(4): 892-904, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: covidwho-772637

RESUMEN

BACKGROUND: During the COVID-19 pandemic, ventilator sharing was suggested to increase availability of mechanical ventilation. The safety and feasibility of ventilator sharing is unknown. METHODS: A single ventilator in pressure control mode was used with flow control valves to simultaneously ventilate two patients with different lung compliances. The system was first evaluated using high-fidelity human patient simulator mannequins and then tested for 1 h in two pairs of COVID-19 patients with acute respiratory failure. Patients were matched on positive end-expiratory pressure, fractional inspired oxygen tension, and respiratory rate. Tidal volume and peak airway pressure (PMAX) were recorded from each patient using separate independent spirometers and arterial blood gas samples drawn at 0, 30, and 60 min. The authors assessed acid-base status, oxygenation, tidal volume, and PMAX for each patient. Stability was assessed by calculating the coefficient of variation. RESULTS: The valves performed as expected in simulation, providing a stable tidal volume of 400 ml each to two mannequins with compliance ratios varying from 20:20 to 20:90 ml/cm H2O. The system was then tested in two pairs of patients. Pair 1 was a 49-yr-old woman, ideal body weight 46 kg, and a 55-yr-old man, ideal body weight 64 kg, with lung compliance 27 ml/cm H2O versus 35 ml/cm H2O. The coefficient of variation for tidal volume was 0.2 to 1.7%, and for PMAX 0 to 1.1%. Pair 2 was a 32-yr-old man, ideal body weight 62 kg, and a 56-yr-old woman, ideal body weight 46 kg, with lung compliance 12 ml/cm H2O versus 21 ml/cm H2O. The coefficient of variation for tidal volume was 0.4 to 5.6%, and for PMAX 0 to 2.1%. CONCLUSIONS: Differential ventilation using a single ventilator is feasible. Flow control valves enable delivery of stable tidal volume and PMAX similar to those provided by individual ventilators.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Respiración Artificial/métodos , Ventiladores Mecánicos , Equilibrio Ácido-Base , Adulto , Presión de las Vías Aéreas Positiva Contínua , Infecciones por Coronavirus/complicaciones , Estudios de Factibilidad , Femenino , Humanos , Rendimiento Pulmonar , Masculino , Maniquíes , Persona de Mediana Edad , Oxígeno/sangre , Pandemias , Neumonía Viral/complicaciones , Respiración con Presión Positiva , Respiración Artificial/instrumentación , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Espirometría , Volumen de Ventilación Pulmonar , Ventiladores Mecánicos/provisión & distribución
18.
Life Sci ; 257: 118113, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: covidwho-652999

RESUMEN

AIMS: To create a low-cost ventilator that could be constructed with readily-available hospital equipment for use in emergency or low-resource settings. MAIN METHODS: The novel ventilator consists of an inspiratory limb composed of an elastic flow-inflating bag encased within a non-compliant outer sheath and an expiratory limb composed of a series of two, one-way bidirectional splitter valves derived from a self-inflating bag system. An Arduino Uno microcontroller controls a solenoid valve that can be programmed to open and close to produce a set respiratory rate and inspiratory time. Using an ASL 5000 Lung Simulator, we obtained flow, pressure, and volume waveforms at different lung compliances. KEY FINDINGS: At a static lung compliance of 50 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 16 and 5 cm H2O, respectively, tidal volumes of approximately 540 mL were achieved. At a static lung compliance of 20 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 38 and 15 cm H2O, respectively, tidal volumes of approximately 495 mL were achieved. SIGNIFICANCE: This novel ventilator is able to safely and reliably ventilate patients with a range of pulmonary disease in a simulated setting. Opportunities exist to utilize our ventilator in emergency situations and low-resource settings.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Neumonía Viral/fisiopatología , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Resistencia de las Vías Respiratorias/fisiología , Betacoronavirus/patogenicidad , Humanos , Pulmón/fisiología , Pandemias , Frecuencia Respiratoria/fisiología , Volumen de Ventilación Pulmonar/fisiología , Ventiladores Mecánicos/provisión & distribución
19.
Salud Publica Mex ; 62(5): 590-592, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-621907

RESUMEN

On April 12, 2020, a bioethics guide for allocating scarce hospital resources during the current Covid-19 pandemic was posted on the website of the Consejo de Salubridad General(CSG) of the Government of Mexico. The guide, entitled Guía bioética para asignación de recursos limitados de medicina crítica en situación de emergencia, was intended as a preliminary document, but the website posting did not describe it as a first step in the process. The publicity resulted in a wide array of comments and criticisms. That first version posted on the CSG website contained an age-based criterion for breaking a tie between two or more medically eligible patients who needed of a ventilator: younger patients would have prefer-ence over older ones. The final version of the guide eliminated that criterion and instead, relied on the leading public health principle, "save the most lives", without regard to personal characteristics other than the possibility of benefitting from the scarce medical resources.


Asunto(s)
Discusiones Bioéticas/normas , Infecciones por Coronavirus , Recursos en Salud/provisión & distribución , Pandemias , Neumonía Viral , Guías de Práctica Clínica como Asunto , Asignación de Recursos/ética , Triaje/ética , Ageísmo , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Toma de Decisiones , Disentimientos y Disputas , Necesidades y Demandas de Servicios de Salud , Humanos , Esperanza de Vida , México , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Justicia Social , Triaje/normas , Valor de la Vida , Ventiladores Mecánicos/provisión & distribución , Privación de Tratamiento/ética , Privación de Tratamiento/normas
20.
Int J Health Geogr ; 19(1): 36, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: covidwho-757061

RESUMEN

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.


Asunto(s)
Áreas de Influencia de Salud/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Recursos en Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , Accesibilidad a los Servicios de Salud/organización & administración , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Illinois , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias , Factores Socioeconómicos , Análisis Espacial , Ventiladores Mecánicos/provisión & distribución
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